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All the answers on ADHD copied together into a single large document.
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All about ADHD (Attention-Deficit/Hyperactivity Disorder)
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Written by: Martin Winkler
First version:
22 Jul 2008.
Latest revision:
08 Jan 2009.
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Answer:
Many FAQs about ADHD copied together as one large article
What is the Difference between ADD and ADHD?
Question:
What is the difference between ADD and ADHD?
Answer:
During the last years many different terms for children, adolescents and adults with ADHD have been introduced. They were mainly influenced by American descriptions of the classification system DSM-IV:
-
ADHD (Attention-Deficit/Hyperactivity Disorder)
is the term used in the current Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR) diagnostic criteria.
-
ADD (Attention Deficit Disorder) with or without hyperactivity
is the older term from the DSM-IIIR. So in some older literature you will find this term as a synonym for ADHD.
Thomas Brown describes common symptoms of ADD (inattentive type):
-
Often easily distracted by extraneous stimuli
-
Often difficulty following through on instructions from others
-
Difficulty sustaining attention
-
Often does not seem to listen to what is being said
-
Tendency to lose things necessary for tasks or activities
-
Difficulty organising goal-directed activities
-
Often shifts from one incompleted activity to another
Some research shows that children with hyperactive-impulsive symptoms
tend to have more behavioural problems and conduct disorder, while
children with the inattentive type (ADD) have a higher risk of comorbid
depression or anxiety disorders.
This FAQ: adhd-add-difference
Sources
ADHD - Age of Onset
Question:
What is the age of onset for ADHD?
Answer:
The diagnostic criteria of ADHD according to the international
classification systems (ICD 10 or DSM IV) define the maximum age of onset
of some symptoms of ADHD before the age of seven. These symptoms have to be
severe and create impairments of academic or social functioning. If a child
has only minor problems (compared to any other child of his age and
developmental stage) the age-of-onset criterium would not be met.
ADHD is a genetically transmitted disorder. Some mothers will be able to
describe symptoms of ADHD of their kids during pregnancy or in early
years. But usually these symptoms cannot be distinguished from the normal
development of toddlers. Usually at the time of kindergarten or the early
years of school children with ADHD will present typical symptoms of ADHD
because they get more problems to adapt to social rules with other
children or teachers and might also have problems with their low
attention span or distractibility and low impulse control.
However, children (especially girls) with the inattentive-type of ADHD
might be able to compensate these problems for a longer period. So there
are also some children who do not have severe impairments in school and
make execellent tests. Becoming older and having higher (or different)
demands of self-organisation and executive functions they might get
typical problems. Some young women present typical symptoms of ADHD with
hormonal changes at the age of 13 or 14. There is no general agreement
among experts how to classify this type of ADHD-like symptoms if no
severe ADHD-symptoms were described before the age of 7. However most
doctors would recommend a trial of ADHD-treatment for these patients if
they met the other diagnostic criteria of ADHD and other possible causes
can be excluded.
This FAQ: adhd-age-onset
Sources
ADHD and Consistent Consequences
Question:
How can I change the behaviour of my child with ADHD? What are the basic principles of behaviour modification?
Answer:
The famous American ADHD-expert Russel Barkley emphasizes the need for
immediate positive consequences in the behaviour modification of ADHD
children.
-
Use more immediate consequences
-
Use a greater frequency of consequences
-
Employ more salient consequences
-
Start incentives before punishments
-
Strive for consistency
-
Plan for problem situations and transitions
-
Keep a disability perspective
-
Practice forgiveness
This is very hard to achieve - especially if one or both parents are also
affected by ADHD.
This FAQ: adhd-basic-rules
Sources
ADHD and Bedwetting
Question:
Is ADHD associated with bedwetting or bowel problems?
Answer:
Many parents of ADHD children say that their children have problems with
bedwetting and bowel control. More.
Dr Barry Duel and colleagues at the University of California, Irvine
College of Medicine found children with ADHD were three times more likely
to suffer from bedwetting and poor bowel control than children without
this behavioural disorder. ADHD children often have this kind of
developmental problems. They have difficulties to get a correct awareness
of bladder control.
Imipramin, a tricyclic antidepressant commonly used for bedwetting
problems, is also a useful therapy for ADHD. So maybe there is a
biological connection between these problems. More.
This FAQ: adhd-bedwetting-pro
Sources
ADHD - Behavioral Modification
Question:
What is Behavioral Modification in the treatment of ADHD?
Answer:
Behavioral Therapy is a very well tried way to change certain habits and
behaviors by increasing the frequency of acceptable (wanted) behavior and
decrease the frequency of unacceptable behaviors.
Behavior Modification is a term that describes this approach with certain
programs that have been developed for children, adolescents or adults
with ADHD. The basis of behavioral modification are rewards and
consequence structure. Positive feedback (appraisal or any kind of
immediate reward) are given for "good" behavior. So the child will try to
increase this behavior to please the parents (or get the reward).
More Article on Behavioral Therapy for ADHD bei the American Academy of Pediatrics
This FAQ: adhd-behav-modif
Sources
ADHD and Frontal Lobe Dysfunction
Question:
Is ADHD caused by frontal lobe dysfunction? What is the influence of frontal lobe dysfunction? What are executive functions?
Answer:
The frontal lobe of the brain is a very important part of a complex
cognitive processing system, and has many connections to different areas of
the brain. It has a special role in planning and organising different tasks
like a "supervisor". Many aspects of everyday life are mainly controlled by
the frontal lobe system:
-
Decision-making and planning of new situations
-
Error detection and correction and developing plans for trouble-shooting
-
Technically difficult or new situations with demand for new solutions
-
Resisting temptations and habitual responses
-
Impulse control and dealing with frustrations
So intention, planning and goal directed behaviour are mainly controlled
by the frontal lobe. These higher cognitive functions of the brain are
also called "executive functions". They are necessary to set goals, plan
to achieve them, carry out plans and directions and maintain interest and
efforts to finish a task.
Impairments of the executive functions will cause severe problems to
adapt to new situations.
This FAQ: adhd-cause-frontal
Sources
Sugar and Hyperactivity
Question:
Does sugar cause hyperactivity? Does sugar cause ADHD? Should I restrict sugar to treat conduct problems?
Answer:
No! Despite clinical research results to the contrary many parents and
even some doctors believe that sugar intake is linked to hyperactivity or
mood swings in children. A long time ago special diets (Feingold) were used
to reduce symptoms of these children. Other parents postulated phosphate or
food additives to cause adhd-like-symptoms. They might have some effect for
a very short time but cannot influence the outcome of adhd. Actually they
are very hard to handle and might cause additional psychological problems
because your child will not like them at all.
There might be a small subgroup of adhd-children with a special
sensitivity for some food. Trials of sugar restriction or diets should be
restricted to 3 or 4 weeks. A subgroup of children (1-3 %) might show
limited benefit, so it could be worth a trial. But diets and restrictive
eating patterns are a main cause for the development of eating disorders.
Since we have no scientific basis for such an attempt you should better
use a multimodal treatment approach.
More about sugar
This FAQ: adhd-cause-sugar
Sources
ADHD and Obesity
Question:
Is there a link between adhd and obesity?
Answer:
A recent study showed that adults treated for obesity who also had ADHD
have significantly more problems achieving weight reduction as well as a
worse outcome in standard treatment programs.
If one modifies the diagnostic criteria of ADHD and defines the age of
onset of ADHD symptoms at 12 (instead of 7 years), then ADHD is very
frequent among obese individuals. 27.4% of all patients with obesity also
had ADHD. Severe obesity (BMI over 40) had an even higher frequency of
ADHD (42.6% of this treatment group). These patients with both obesity
and ADHD had more hospitalisation and longer treatments with lower
response rates.
Up to now, very little systematic research is available and only few
psychotherapists or doctors will do an evaluation for ADHD in this group
of patients with eating disorder.
The reasons why ADHD and obesity often occur together are unknown. There
are clues that neurotransmitter changes in the dopamine system and reward
centers of the brain are affected.
This FAQ: adhd-comorbid-obesity
Sources
ADHD - Alternative Therapy and the Doctor
Question:
Should I inform my doctor that we use complementary therapy for the ADHD treatment?
Answer:
In a recent study parents of ADHD children were asked to speak about the
use of complementary and alternative medicine (CAM). We know, that a lot of
parents will try them to make every possible attempt to avoid
psychopharmacological treatment with psychostimulants or other forms of
multimodal treatment. 62 of 114 (54%) of the parents had experiences with
this kind of treatment. Reasons to make a trial of this type of treatment
were mainly:
-
a "natural" alternative
-
having more control over the treatment
One important result of the study was that only 14 % of the parents talked
about their treatment approach with their doctor. This might cause severe
problems for the children because even "natural" approaches like
nutritional supplements or dietary manipulations or even high-dose vitamins
can cause severe problems or interactions with medicine.
While scientific results of these "alternatives" are mainly
disappointing, doctors usually will accept these trials of the parents.
But they might also offer more reliable information about the advantages
and possible negative consequences of these treatment approaches.
Up to this point of research there is no alternative or complementary
treatment for ADHD that proved any lasting positive results. You should
be very careful if advertisements or laymen recommend this type of
treatment and promise a "cure" for ADHD symptoms.
More:
http://www.chadd.org/fs/fs6.htm
This FAQ: adhd-complement-therapy
Sources
Concerta twice a day?
Question:
Should my son take Concerta (Methylphenidate-OROS) twice a day? My son (10) was put on 36 mg Concerta (long acting methylphenidate) in a specialised clinic. Now our local doctor wants him to take 18 mg twice a day in the morning and at noon. On mother in our self-help group told me, that this is not recommended. What is your opinion?
Answer:
Concerta is a rather new psychostimulant version, containing the known
methlyphenidate. But it lasts much longer: between 10 and 12 hours due to
a specific transport system (OROS). If your son would take the medicine at
noon he might get severe sleeping problems...
And there is another reason why you should stick to the recommended
dosage of the clinic: The 36mg dose most properly did the best job to
improve the ability to focus and sustain attention. With the lower dose
your son will not have the same benefit.
You should talk to your doctor about this issue. He might not be well
informed about this new drug but it should be easy for him to get
appropriate informations very soon. Maybe one of the members of the
self-help group or a local pharmacists could help you and call your
doctor to discuss this issue.
If he is not willing to change his opinion you should look for a second
opinion.
This FAQ: adhd-concerta-twice
Sources
DAMP
Question:
What is the difference between ADHD and DAMP? What are the core symptoms of DAMP?
Answer:
DAMP = Deficits in Attention, Motor Control and Perception is a
descriptive diagnosis which is commonly used in Scandinavian countries. It
was introduced by the Swedish professor Gillberg in the 80's.
The core symptoms of attention deficits and impulsive symptoms are common
to both descriptions. The main difference is that DAMP also includes
deficits in Perception and Motor control.
A doctor can find characteristic signs of DAMP:
-
coordination deficits
-
deficits in handwriting and other precise motoric functions
-
deficits in sensory perception
Sometimes also "soft signs" are present. These are minor neurological
changes that cannot be explained by a severe neurological disorder. This
might include differences of sensory perception in distinct areas of the
body (or between the right and the left part of the body)
This FAQ: adhd-damp-symptom
Sources
ADHD - Inattentive Type
Question:
What is the inattentive type of ADHD? What is ADD? Can my child have ADHD without symptoms of hyperactivity?
Answer:
The Diagnostic and Statistical Manual, 4th Edition (DSM-IV) describes
three types of ADHD:
-
Predominantly Hyperactive-Impulsive Type
-
Predominantly Inattentive Type and
-
Combined Type.
Children with the mainly Inattentive type of ADHD tend to daydream and
have difficulty focusing. The following criteria are used to diagnose
children with ADHD, Predominantly Inattentive Type. Symptoms must have
been present for at least six months, with onset before age seven:
-
often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities
-
often has difficulty sustaining attention in tasks or play activities
-
often does not seem to listen when spoken to directly
-
often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to
oppositional behaviour or failure to understand instructions)
-
often has difficulty organizing tasks and activities
-
often avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental effort (such as schoolwork or homework)
-
often loses things necessary for tasks or activities (e.g. toys,
school assignments, pencils, books or tools)
-
is often easily distracted by extraneous stimuli
-
is often forgetful in daily activities
This FAQ: adhd-def-inattentive
Sources
ADHD - Diagnostic Criteria, ADHD Diagnosis
Question:
What are the diagnostic criteria of ADHD? How is diagnosis of ADHD done? What does ADHD look like?
Answer:
To meet the diagnostic crtieria according to the DSM-IV (Diagnostic and
statistical Manual of psychiatric disorders) a couple of aspects have to be
considered:
A. Six (or more) of either 1) Inattention, or 2)
Hyperactivity/Impulsivity Symptoms must have
persisted for at least 6 month to a degree that is maladaptive and inconsistent with developmental level:
1) Inattention
-
often fails to give close attention to details or makes careless
mistakes in homework, work, or other activities
-
often has difficulties sustaining attention in tasks or play activities
-
often does not seem to listen when spoken to directly
-
often does not follow through instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to oppositional
behavior or failusre to understand instructions)
-
often has difficulties organizing tasks and aktivities
-
often avoids, dislikes or is reluctant to engage in tasks that require
sustained mental efforts
-
often loses things necessary for tasks or activities (e.g. toys, school
assignments, pencils, books)
-
is often easily distracted by extraneuous stimuli
-
is often forgetful in daily activities
2) Hyperactivity / Impulsivity
Hyperactivity
-
often fidgets with hands or feet or squirms in seat
-
often leaves seat in classroom or in other situations in which
remaining seated is extected
-
often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness)
-
often has difficulty playing or engaging in leisure activies quietly
-
is often "on the go" or often acts as if "driven by a motor"
-
often talks excessively
Impulsivity
-
often blurts out answers before questions have been completed
-
often has difficulty awaiting turn
-
often interrupt or intrudes on others (e.g. butts into conversations or
games)
B) Some symptoms causing impairment were present before age 7
More.
C) Some impaiment from the symptoms is present in two or more settings
(e.g. at school and at home)
More.
D) There must be clear evidence of clinically significant impairment in
social, academic or occupational functioning
More.
E) Occurence is not exclusively during the course of a Pervasive
Developmenal Disorder, Schizophrenia or other Psychotic Disorder and are
not better accounted for by another mental disorder
Basic information about ADHD by the American ADD organisation
This FAQ: adhd-diagn-dsm
Sources
ADHD Lab Tests
Question:
Are there any physical tests to make the diagnosis of ADHD?
Answer:
There are no lab-tests that can determine or exclude ADHD. But it might
be important to rule out some other relevant causes of hyperactivity or
attention problems. So the doctor will do a physical and basic neurological
clinical examination of the patient. Using his eyes and ears and doing some
basic tests of reflexes, motor functions, coordination and testing the
senses of the patient will give a lot of important information.
Then a blood test of the thyroid functions (TSH and maybe thyroid
hormones T3, T4) should be considered. This will normally be done within
a routine check of the patient.
If the patient (or family) has a history of seizure the doctor will do an
EEG. This will not show specific signs of ADHD but might exclude specific
forms of seizures. If the doctor and you decide to use
psychopharmacological treatment an EKG should exclude significant heart
problems.
A scull X-ray (Computer tomography, NMR) can be useful to exclude rare
other causes of attention problems (like malformations of blood vessels,
tumor, hydrocephalus). But these are very rare conditions!
Some parents think very specific diagnosis of functional imaging (SPECT,
PET) will show specific signs of ADHD. At the moment these diagnostic
tools are mainly used for research. You have to consider possible side
effects of nuclear medicine especially for children. So these diagnostic
tools cannot be recommended for a routine diagnosis of ADHD.
This FAQ: adhd-diagnosis-lab
Sources
ADHD - Domains of Impairment
Question:
Do all children with ADHD symptoms have to take psychostimulants?
Answer:
No. But you should always consider all possibilites of improvement
depending on the individual domains of impairment and main target symptoms
of the kid. To develop an appropriate treatment scheme for ADHD children
can only be done by addressing all possible areas of impairment and
personal ressources and interests of the children and their enviroment. So
a multimodal treatment approach will start by gathering information from
the child, the parents, teachers and other relevant persons in contact with
the patients. This will help to assess specific presentations of problems
or coping facilities of the individual patient in different domains.
Symptoms or behaviors in the context of ADHD (or any other psychiatric
diagnosis) will only be treated if they cause problems in the patient«s
life or interfere with the individual development. So medication will
only be one part of a complete treatment approach to help the client to
reach his or her full potential of functioning in all domains of the
individual environment. Sometimes this can be done without medication,
but very often psychostimulants are the basis of a better awareness and
self-controll of the children.
There are very different opinions about the number of adhd children, who
need psychostimulants. Some experts think that less than 30 percent of
all adhd children might need them. Other experts say, that you should
always offer a pharmacological treatment option because it will have the
best outcome for the child on the long run. About 80 percent of all
adhd-children that get a medication will get significant improvements.
Any other treatment approach will not achieve similar benefit for the
children.
To define the individual benefits or side effects of the treatment a
baseline of specific target symptoms should be defined and a close
follow-up (at least once a month in the beginning) should monitor all
positive or negative changes.
This FAQ: adhd-domain-impair
Sources
ADHD Impulsiveness
Question:
Why are ADHD children so impulsive?
Answer:
Impulsiveness is the immediate response to thoughts or deeds without any
consideration of the appropriateness or consequences.
People with ADHD tend to speak, act or move without thinking. Typical
features of impulsiveness may include:
-
rapid decisions without reflecting the consequences
-
impulsive buying and horting
-
Acting without thinking
-
Speaking without any thoughts about the content and appropriate situation
-
Interruption of conversations
-
lack of ability to check details, making false assumptions
Impulsiveness could be also a positive feature. The ability to make rapid
decisions or act can be important for leaders or in a case of emergency.
However, it can also cause severe social problems and is one of the most
disabling problems of ADHD for many patients.
This FAQ: adhd-impulse-symptoms
Sources
Inflexibility and ADHD
Question:
Why do children with ADHD have problems in adjusting to anything new? Why are ADHD children inflexible to any new situation?
Answer:
One very common problem for children, adolescents and adults with ADHD
is the problem to adjust to any new situation. While many ADHD people love
new things or tend to seek new stimuli they have big problems to adjust to
a new enviroment, new homes, teachers at school or any other major changes
in their daily routines. Even new clothes or changes of their favourite
food or drink can cause severe emotional problems and frustrations.
This FAQ: adhd-inflexible-symptom
Sources
ADHD - Begin of pharmacotherapy
Question:
What should we not before we start medication for ADHD?
Answer:
The pharmacological part of the multimodal treatment of ADHD is not
dangerous or you do not have to expect long-lasting or serious
side-effects. But you have to be well informed!
Having made an accurate diagnosis of AD/HD as the primary problem, the
health care professional should have a therapeutic talk about:
-
Patient expectations and goals of the therapy. Sometimes more realistic
goals have to be defined.
-
It is important to explain the basic effects of psychostimulant
medication, but focus on the self-control of the patient. The
psychostimulant will not change the behavior or conduct problem. Every
child will be able to misbehave or make jokes. But if the medication is
correctly working the child should be able to control and inhibit
negative behaviors- if she or he really wants to.
-
A basic principle of self-monitoring of the symptoms and possible
adverse effects should be established
-
Information about the risks and benefits of pharmacotherapy
-
Likelihood of adverse effects and problems in the titration of the
right dose. The patient and/or parents should be familiar with possible
symptoms of lack of medication (rebound) and overdoses.
Start the medication only if you and your child are well educated and
familiar with the basic principles of medication and agree with this
treatment option! If you or your child have any serious concern do not
hesitate to ask for further information. You should also try to connect
to other parents in a self-help group! More about medication for ADHD
This FAQ: adhd-med-start
Sources
Medication for ADHD/ADD: Methylphenidate (Ritalin/Concerta) and Others
Question:
What medication can be used for the treatment of ADHD/ADD? Do you recommend Methylphenidate (Ritalin/Ritalina/Concerta) or other medication?
Answer:
Pharmacotherapy is one option of a multimodal treatment approach of
ADHD. While stimulants (methylphenidate or amphetamine) are the treatment
of choice some antidepressant medication has also positive effects for the
treatment of ADHD .
Methylphenidate is the name of the most commonly used medication for the
psychopharmacotherapy of ADHD. Brandnames of drugs with Methylphenidate
are Ritalin, Ritalin-SR, Ritalin LA or Concerta and Metadate. There are
also some generic medication with Methylphenidate (Equasym, Medikinet).
Methylphenidate is a central nervous system stimulant, or a CNS stimulant.
To achieve positive effects for ADHD patients the main target of the
medication is the dopamine system of the brain. The most relevant
neurobiological problem of ADHD can be explained as a malfunction of the
dopamine transporter system. These transporters are responsible for the
reuptake of dopamine from the synaptic gap into the nerve cells. If the
activity (or number of transporters) is too high, the available dopamine
is too low.
Are parents doping their children?
This FAQ: adhd-medication-treat
Sources
ADHD Kids and Common Myths: Parents Against Ritalin - Are Parents
Doping their Children?
Question:
Is Ritalin only an attempt to dope up problem children? Should we listen to the claims from organisations like "Parents Against Ritalin"? Is it true that parents are doping their children?
Answer:
Myth: PARENTS WHO GIVE THEIR KIDS ANTI-ADHD DRUGS ARE DOPING UP PROBLEM CHILDREN.
Some people claim that medicating ADHD children is only a frustrated
attempt to explain failures in parenting and to explain inattention,
incompetence and inability of adults (or teachers) to control these
children. These people say parents try to mask their own failings and use
medicine to calm children down.
This is unfair because most of these people never got contact with any
ADHD children or the parents for a longer period. People without such
children have no idea what it's like.
They very often rely on wrong information which is influenced by authors
like Breggin or even misinformation posted by Scientology church. There
are strong interests for such wrong information and emotional discussions
concerning ADHD and stimulant medicine in the public media. But they are
not talking to selfhelp-organisations or parents but only to authors with
no experience in the field of ADHD who try to get publicity for their own
books or institutes.
Randomized, controlled studies in both the United States and Sweden have
tried combining medication with behavioural interventions and then
dropped either one or the other. For those trying to go on without
medicine the behavioural interventions maintained nothing. Only the
combination of pharmacotherapy with psycho-social intervention and
behavioural interventions for ADHD can achieve better results.
Behavioural therapy is of special importance if comorbid disorders like
conduct disorder or symptoms of secondary depression or anxiety are
present.
Myth and Scientific Evidence
More information from the American CHADD organisation
Medication for ADHD treatment
This FAQ: adhd-myth-dope
Sources
Negative Self-Esteem of ADHD Children
Question:
Why do children with ADHD develop negative beliefs and feelings?
Answer:
A negative self-esteem with self-destructive beliefs and feelings of
despair is very common among children and adolescents with ADHD. This can
be a consequence of failures caused by disturbed attention, impulsive
reactions and behaviour and rejection by classmates or even their teachers.
This FAQ: adhd-neg-feeling
Sources
Adhd and Pathologic Gambling
Question:
Is there any connection between ADHD and Gambling problems?
Answer:
ADHD patients are prone to a variety of other impulse control disorders.
Rates of impulse control disorders usually do not differ in gender but the
"choice" of impulsive behaviours may be different. Some experts of gambling
addiction report a very high co-occurence of ADHD and pathologic gambling
and say that up to 20% of the patients with gambling addiction show traits of ADHD. Another impulsive disorder can be diagnosed in 35 % of pathologic gamblers (compulsive buying or compulsive sexual disorders) compared to 3%
prevalence in the control groups.
Most therapies of pathologic gambling will not handle this topic because the knowledge is still limited. But it might be worse to look for traits of ADHD and make a multimodal treatment approach including
psychopharmacotherapy.
This FAQ: adhd-pathol-gambling
Sources
Causes of ADHD
Question:
What are the causes of ADHD?
Answer:
The FAQ about neurobiological aspects and psycho-sozial influences of
ADHD has not been translated yet. The American self-help organization CHADD
offers a good basic information about this topic.
More. If you are intersted in genetic factors contributing to ADHD read this
information provided by the University of California
More.
This FAQ: adhd-patinfo-cause
Sources
ADHD - Persistence of Symptoms
Question:
Are short periods of distractibility or hyperactivity enough to make the diagnosis of ADHD?
Answer:
To make the diagnosis of ADHD symptoms must have persisted for at least
six months. There a normal fluctuations of the presentation of symptoms or
changes within different environments. But the impairments have to meet the
criteria of pervasiveness and severity and may not be caused by
intermittent changes of the social environment or due to other acute
problems.
During the diagnostic process other possible causes of hyperactivity,
attention deficits or distractibility or problems of impulse control have to be excluded. Important other causes of these symptoms could be:
-
organic disorders
-
recent trauma (but also early sexual abuse or other traumatic experiences)
-
substance abuse
-
onset of an other psychiatric disorder (depression, anxiety disorder)
-
social problems or severe interpersonal problems at home
If problems are only present at school but everything is fine during
holidays, one should be very careful to consider ADHD.
Some parents or teachers try to make a diagnosis after reading a book
with ADHD-checklists. Simply knowing the symptoms of ADHD or having
problems in distinct areas of behaviour or school performance is not
enough to consider a clinical diagnosis. You need to refer to an expert
to rule out other possible disorders and find the best help for your child.
This FAQ: adhd-persist-symptoms
Sources
Advantages of ADHD
Question:
What are the advantages of ADHD? What are positive aspects of ADHD?
Answer:
While diagnostic criteria and treatment plans focus on negative aspects
of hyperactivity, impulsive problems or attention deficits, there are a lot
of positive aspects of ADHD children, adolescents or adults. Not all ADHD
people will have all these positive traits or qualities but usually you
will find a broad variety of strenghts.
This is one of the reasons why many parents do not want their children to
be changed by psychopharmacotherapy or behavioural treatment. Some
positive aspects of ADHD can be:
-
creativity
-
charming personality, warmheartedness
-
good judge of character
-
sense of humor
-
quick to grasp essentials
-
flexibility
-
intuitiveness
-
sensitive to surrounding environment
-
enthusiastic, passionate
-
forgives mistakes
-
tries to do better next time
-
willing to take risks
This FAQ: adhd-positive-aspects
Sources
ADHD a Real Disorder
Question:
Is ADHD a real disorder?
Answer:
Myth: ADHD ISN'T A REAL DISORDER.
Wrong! All paediatric and psychological or psychiatric organisations
accept ADHD. In fact, it is the most common mental disorder of children
and adolescents.
Some people say, ADHD is not a real disorder because scientists cannot
identify a cause of ADHD. The hyperactive behaviour of the children
should be more or less "normal" like "ants in the pant" or signs of bad
parenting or lack of motivation at school. These children could be
stimuli driven due to a change of the environment like too much TV or a
lack of attention of their parents.
One of these opponents is Thomas Armstrong. He says: "ADHD is a disorder
that cannot be identified in the same way as polio, heart disease or
other legitimate illnesses." But the diagnosis or psychological problems
or psychiatric diseases like depression, anxiety disorders or dementia is
not based on lab tests. Dr. Russel Barkley, a famous ADHD expert,
explains that we do not have such tests for headaches, multiple sclerosis
or Alzheimer. We would eliminate nearly all mental disorders, if we would
only diagnose or treat "diseases" with a single lab test for diagnosis.
However, there is convincing evidence for a biological vulnerability of
ADHD. Epidemiological evidence indicates that ADHD has a powerful genetic
component. University of Colorado researchers have found that a child
whose identical twin has the disorder is between eleven and 18 times more
likely to also have it than is a non-twin sibling. Genetics is a special
area of interest in the area of ADHD research. Scientists have identified
several possible genes that influence the symptoms and severity of the
disorder. Additional functional anatomy with SPECT or PET diagnosis can
show distinct changes in the blood flow of ADHD adults and changes in the
dopamine system (Dopamine transporter DAT) which are typical for ADHD.
But this of course is not a method to diagnose ADHD in a clinical setting
due to extreme high costs and possible adverse effects of the diagnostic
tools (low radiation) for children.
This FAQ: adhd-real-disorder
Sources
Psychostimulants and Driving a Car
Question:
Can I drive a car if I take Ritalin?
Answer:
Yes. But you must have a prescription of the psychostimulants of your
doctor. Otherwise a drug test of your urine might show the psychostimulants
and you can get serious trouble with the police.
There is ongoing research in the area of driving performance and ADHD. Up
to now most scientist have no doubt that you will show a better driving
performance if you take medicine. But you should also consider that your
attention and awareness can differ extrem. If you are not used to the
"new" perceptions of your enviroment (at the very beginning of a
psychopharmacological treatment) you should not drive a car.
This FAQ: adhd-ritalin-car
Sources
ADHD Dysphoria and Psychostimulant Medication
Question:
Is dysphoria or irritability a common side effect of psychostimulant medication? My 9 year old girl Daniela got methylphenidate for about 2 weeks now, starting with 5 mg bid. Now the teacher noticed some improvement of attention, but she feels dysphoric and irritable in the afternoon. Should we stop medication?
Answer:
Any emergence of mood changes (irritability or dysphoria) or agitation
is very relevant and should be reported to the doctor! There a many
possible causes that could contribute to this change.
-
Titration of the right dose
The medication needs to be monitored and adapted to the personal needs.
So the child might need a higher dose of the medication or might be very
sensitive to psychostimulants. This should be evaluated!
- Rebound
Normal methylphenidate pills work for about 3 to 4 hours. After that
time a "rebound" of the old symptoms can occur. The patients feel very
uncomfortable with this. Adaption of the right dose and intervall is
necessary or you might try long-acting psychostimulants instead.
-
Change stimulant preparation
Some children do not respond to methylphenidate but do fine with
amphetamines.
-
Evaluate comorbid disorders like depression or anxiety disorders!!!
-
Assess sleep.
Many adhd children have severe problems at night. If they cannot
sleep they might feel irritable and dysphoric.
This FAQ: adhd-sideeffect-dysphoria
Sources
ADHD or Sleep Deprivation?
Question:
Is it ADHD or too little sleep?
Answer:
Sleep deprivation will influence the cognitive function of the brain! So
it is very important to rule out sleep problems or lack of sleep due to TV
or other activities during nightime. Sleep research showed that 11 and 12
year olds, who get less than 6.5 hours of sleep per night had similar
attention and behaviour problems that mimicked ADHD. These kids are often
irritated and defiant and had additional problems at school. It is very
important to get enough sleep! One night of sleep loss can reduce the brain
processing capacity by 30 to 40 %! Two nights without sleep will reduce the
attentive and cognive functions by 60-70%!
So it is very important to make sure your child (and you) gets enough
sleep!
How much sleep is enough?
-
infancy/toddler: 17-18 hours
-
4 year old: 10-12 hours
-
10 year old: 9-10 hours
-
18 year old: 8-9 hours
-
30 year old: 7-8 hours
-
60 year old: less than 6-7 hours
This FAQ: adhd-sleep-enough
Sources
Stimulants and Growth Suppression
Question:
Do psychostimulants cause growth suppression?
Answer:
No.
ADHD children usually show some delay of the personal development,
including a different growth pattern. The neurotransmitter Dopamine plays
an important role in the regulation of the growth hormones and
prolactine. Recommended doses of stimulants do not influence the hormone
levels, but due to loss of appetite a slight delay of weight gain could
occur.
The optimal medication dose should be adapted on a regular schedule at
least every 6 months. Very often older children need LOWER stimulant doses.
Usually children with ADHD will reach a normal growth and weight in late
puberty, sometime 1 or 2 years later than their classmates. Only a very
small number of children will remain a little bit smaller than expected.
This will not be caused by the medication but could be a result of
additional hormonal disturbances.
This FAQ: adhd-stim-growth
Sources
Side Effects of Psychostimulants like Ritalin, Concerta (Methylphenidate)
Question:
What are typical side effects of Psychostimulants like Ritalin, Concerta (methylphenidate)? What are adverse effects of them?
Answer:
Typical side effects of psychopharmacotherapy with stimulants like
methylphenidate (Ritalin, Concerta) or amphetamines are usally mild and
restricted to the first days or weeks of therapy. Typical adverse effects
can be explained by the stimulation of the autonomic nervous system
(sympathetic and parasympathecic).
The
activation of the sympathetic nervous system can cause a mild increase of the pulse. But some patients report
palpitations or tachycardia (trembling or fast, irregular heartbeat).
Usally this will not cause any severe problems. The
blood pressure might increase a little bit, usally not more than 5 mm Hg. This is
relevant for patients with hypertension problems.
Sometimes this can also cause symptoms of
dizziness. The most common side effect due to the activation of
the sympathetic nervous system are
sleep problems (insomnia). So usally stimulants will not be given in the late
afternoon or evening. (But some patients have less sleeping problems if
they take a low dose of stimulants in the late afternoon because their
brain calms down). Typical reaction on the parasympathic system are:
-
low appetite and stomach problems
-
sometimes headaches
Severe or long-lasting side effects are extremly rare! However every medication could cause an allergic reaction. Usally these
are not caused by the stimulant but by additional substances of the
tablet
-
Severe toxic effects
of methylphendiate have not been described in literature. An older
other psychostimulant called Pemolin (Cylert) has rare liver
complications, so that a special monitoring is required if the doctors
uses this stimulant. However methlphenidate causes no damages or
alterations of this kind.
-
Neurotoxicity
Some people are afraid of possible alterations of nerve cell groth or
brain development using methylphenidate. Actually a German
neurobiologist tried to get attention in the media saying
methylphenidate might cause Parkinsonism. Yes, dopamine is of special
importance for ADHD. Yes, psychostimulants act on the dopamine
transporter in the brain. But NO: There is no connection between ADHD
and Parkinson. There is not a single case where any ADHD child
developed symptoms of Parkinson in later life.
-
Growth Supression
More.
This FAQ: adhd-stim-sideeffect
Sources
Toxic Effects of Psychostimulants
Question:
Do psychostimulants have toxic effects?
Answer:
The common psychostimulants for the treatment of ADHD in children,
adolescents and adults (methylphenidate and amphetamines) have no (or
extremely rare) toxic effects.
Any medicine could cause allergic reactions or sometimes alterations of
the number of red or white blood cells. However, this is extremely rare.
The doctors usually make some blood tests at routine visits once or twice
a year.
One older psychostimulant (Pemolin) had rare toxic effects on the liver,
so a close monitoring of the liver enzyme was necessary.
Methylphenidate (Ritalin, Concerta) does not cause these alterations!
This FAQ: adhd-stim-toxic
Sources
Stimulants and Sleeping Problems
Question:
Do psychostimulants cause insomnia or nightmares?
Answer:
Sleeping problems seem to be closely related to ADHD. Many children,
adolescents or adults have problems to calm down in the evening and fall
asleep or report disturbed sleeping patterns or nightmares.
Psychostimulant medication can cause insomnia in some patients. However
there is a significant group of patients that will even benefit from low
dose psychostimulant in the afternoon or before bedtime to calm down!
To find out whether the psychostimulant medication is responsible for the
sleeping problem you could try to administer the medication earlier and
to reduce or avoid medication after 2 pm.
If you administer sustained release medication (e.g. Concerta) with a
very long duration you might consider to change the tablet or dose.
Sometimes comedication with sedating antihistamine medication or
Clonidine can be helpful.
However, it is important to establish sleeping routines and stick to
defined times to go to bed. Try to reduce TV times or too much computer
games in the late afternoon or evening because this can be a source of
overstimulation of the brain.
This FAQ: adhd-stimul-insomnia
Sources
Is Ritalin/Concerta and other Medications for ADHD Good Treatment or
is there a Risk for Abuse?
Question:
Is Ritalin/Concerta and other medications for ADHD good treatment or is there a risk for abuse?
Answer:
Targets of Psychostimulant Pharmacotherapy
Psychostimulants like Methylphenidate (Ritalin, Concerta) are known for
treating "hyperactivity". However, this is only one symptom of ADHD that
can be altered by this medication. In a multimodal treatment approach of
ADHD stimulants positively affect not only the core symptoms of ADHD
(hyperactivity, attention deficits and impulsivity) but proved to have
lasting effects on:
-
Specific cognitive functions of learning, working memory and other
attention functions.
-
Improved social functioning with better peer interactions, more friends
and prosocial behaviours.
-
Better classroom behaviour and academic functioning with reduction of
off-task behaviour, disruptive behaviour and following directions of the
teachers.
-
Relationships with the parents and siblings improves. Fewer anger
outbursts or off-task behaviour.
-
Mood improvement with less aggressive and disruptive behaviours.
This can have a big influence on the development of self-esteem and
social interaction. While children with ADHD have a higher risk for
substance abuse or addiction the treatment with psychostimulants prevents
this bad outcome for them.
For children with additional Oppositional Defiant Disorder or Conduct
Disorder psychostimulants proved to have a benefit as well. Aggression,
lying, stealing or other conflicts with the law are influenced. Usually
these kids are less prone to severe accidents if they are treated with
psychostimulants within a good medical and psychosocial setting.
This FAQ: adhd-stimul-target
Sources
ADHD - Distractibility
Question:
What are typical symptoms of distractibility of ADHD
Answer:
Children, adolescents and adults with ADHD are easily distracted by
stimuli in their environment. This can be any other important or irrelevant
accustic or visual stimuli. So ADHD is characterized by the inablity to
control what one pays attention to. The children with ADHD are not able to
inhibit other stimuli or to stay focused to one task. Actually many ADHD
children can focus on a very interesting task (hyperfocussing), but are not
able to shift their attention focus in an appropriate way.
A typical problem for adhd children are "boring" tasks like doing
homework or cleaning up their room. Usally any other stimuli (e.g. a bird
outside the window, a dog barking next door, or a toy) will distract the
child. Now the attention focus has complety changed, the old task is "off
mind".
This FAQ: adhd-symptom-distract
Sources
ADHD Change of Symptoms
Question:
Do children eventually "outgrow" ADHD?
Answer:
Our doctor told us that there is no need for further medication or
treatment for adolescents. Do adolescents eventually outgrow ADHD?
No. ADHD is a neurobiological based disorder. We know that at least 60 %
of all children with severe ADHD will continue to show severe symptoms as
adults. But symptoms might change: Hyperactive movements or impulsive
behaviours might be reduced. So some children do no longer meet the
diagnostic criteria for the hyperactive-impulsive type. But normally they
will still have attentional problems and even more problems due to
deficits of their executive functions and self-organisation.
So they might "outgrow" diagnostic criteria, but will still have the
neurobiological vulnerability of ADHD.
This can cause different kinds of problems in later life due to
maladaption at work, partnership or secondary problems of substance abuse
or impulsive behaviours.
Many ADHD-adolescents are especially prone to substance abuse problems or
problems with discipline at school or work due to their deficits in
impulse control and self-organisation. However, many adolescents or
adults develop positive traits and can use positive aspects of this
"disorder". They learn to adapt in every day life and will no longer feel
handicapped by ADHD-symptoms. But the biological vulnerability is still
present.
This FAQ: adhd-symptoms-outgrow
Sources
Toddlers and ADHD
Question:
What of are typical symptoms of ADHD in Infancy? Is excessive crying A symptom OF ADHD?
Answer:
ADHD characteristics in the Infancy, Toddler and Preschool Stages
It is very difficult to make a proper diagnosis for very young children.
Normal development has to be carefully evaluated. Most of the research
has focused on children with conduct problems and is mostly
retrospective. But if a genetic predisposition or siblings with ADHD are
present, the following symptoms might also be related to ADHD-traits:
-
Excessive crying
-
Difficulties to be soothed
-
Hypersensitivity for touching or certain clothes
-
Feeding problems, irregular eating
-
Sleep disturbances
-
colics
Theses symptoms can cause severe mother-child difficulties with stress
and lower self-esteem of the parents. Especially excessive crying and
sleeping problems can cause additional psychological problems for the
mother. Very often they try every tip of friends of relatives, but they
do not work! So the mother thinks, the symptoms might be due to bad
parenting.
ADHD is a genetically based disorder. So the mother or father (and often
both) might also be affected by ADHD. So they might have additional
problems with organizing and impulse-regulation. Up to now there is very
little help for these families. The best thing is to seek professional
help by a doctor or psychotherapist. Psychostimulants are not recommended
for very young children before preschool.
This FAQ: adhd-symptoms-toddler
Sources
Situational Variation of ADHD Symptoms
Question:
Why do symptoms of ADHD patients change markedly in different situations? My 6 year old son Ben shows dramatic changes of his attention span and impulsive behavior if he finds a task interesting or gets immediate rewards. However at school and at home the major problems of his ADHD are still present. Is this a typical feature of ADHD?
Answer:
While the core features of ADHD have to be prolonged and present in
different situations there can be marked changes of the visible symptoms or adaption to a specific situation as a consequence of the specific situation or individual interests and coping facilities. Usually ADHD children do better in one-to-one situations, in new or competitive situations (like video games, sports competition) or if they can get immediate rewards for their efforts.
Many parents say that their children have less problems to complete their tasks (homework), if someone is in the room to supervise them. This could help the children to focus and reduce the risk of daydreaming.
Some children need rather specific situations, like background music, or have less problems if they get help from a friend who takes notes of the school day.
Controversially those with ADHD manifest more problems in group settings
because they have problems to track conversations. Any boring work will
not be completed in a reasonable time span if not supervised and rewarded
in an appropriate way.
This FAQ: adhd-symptoms-variation
Sources
Diets for Children with ADHD and other Controversial Therapies for ADHD
Question:
What are alternative therapy approaches for ADHD? Is there a natural alternative therapy for ADHD? Are there special diets for children with ADHD?
Answer:
-
Dietary Intervention. The changing of a child's diet to prevent ADHD.
Conclusion: No scientific evidence of effectiveness
-
Megavitamin and Mineral Supplements. The use of very high does of
vitamins and/or minerals to treat ADHD. Conclusion: No scientific
evidence of effectiveness.
-
Anti-Motion Sickness Medication. Conclusion: No scientific evidence of
effectiveness.
-
Candida Yeast. Those who support this model believe that toxins created
by the yeast overgrow and weaken the immune system making the individual
susceptible to many illnesses including ADHD. Conclusion: No scientific
evidence of effectiveness.
-
Algae. Those who support this treatment believe blue-green algae to be
a nutritional supplement for ADHD. Potential liver damage and no proof
for effectiveness.
-
Applied Kinesiology (Chiropratic approach). This theory believes that
Learning Disabilities are caused by 2 specific bones in the skull.
Conclusion: No scientific evidence of effectiveness.
-
Optometric Vision Training. This proposes that reading related
Learning Disabilities are caused by visual problems. Conclusion: No
scientific evidence of effectiveness.
-
EEG Biofeedback. Proponents of this approach believe that ADHD
children can be trained to increase the type of brain-wave activity
associated with sustained attention. Conclusion: No scientific
evidence of effectiveness.
This FAQ: adhd-thr-contro
Sources
Tracking Conversations
Question:
I have big problems listening and tracking conversations. What should I do?
Answer:
Their are many possible causes, why people have problems to track
relevant information in a conversation.
Possible causes are:
-
hearing problems / tinnitus / hyperacusis
-
lack of concentration due to sleep problems
-
chronic worrying about problems (e.g. work related problems)
-
depressive symptoms
-
daydreaming
-
low interest in the topic of conversation
Try to find out what might contribute to your problem. Some people
have severe problems in group settings due to social anxiety or
fears. This might cause high tension and reduced ability to focus on
conversation.
If you have a history of attentional problems, distractibility and
/ or hyperactive symptoms (or children with these problems) you
should also consider an residual form of ADHD (Attention Deficit
Hyperactivity Disorder).
This FAQ: adhd-track-conversation
Sources
ADHD is a Chronic Condition
Question:
What kind of management program should primary care clinicians recommend for ADHD?
Answer:
ADHD has to be considered as a chronic conditition, that might interfere
with the further development and quality of life of the children. Studies
indicate that persistence of ADHD into adolescence and adulthood will
affect at least 60 to 80% of the ADHD children. It is important to develop
an ongoing partnership among clinicians, parents, teachers or any other
person who is relevant for the child and the further development.
Therefore special efforts for a long-term management of ADHD are
recommended:
-
Appropriate information about the condition and possible individual
problems.
-
Focus on individual strengths and resources of the child and the
family!!!!
-
Update and monitoring of the family knowledge and understanding of ADHD
and any treatment options. Also alternative treatment methods should be
considered, because more than 60% of all parents will at least try one
or more methods.
-
Counselling about the possible reactions of the family, friends,
teachers...
-
Developmentally appropriate education of the child about ADHD. Again:
Consider resources and strengths of the child!
-
Availability to any kind of questions, problems or crisis intervention.
-
Offer additional support for coaching or explain the ADHD symptoms at
school.
-
Connect to other ADHD-families (self-help-groups, internet).
-
Monitoring of any positive or negative changes and adjustment of the
treatment plan/medication.
This FAQ: adhd-treat-chronic
Sources
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